PHILOSOPHY AND CONCEPT OF TOTAL ANNULUS EXCISION (TAE): A NOVEL APPROACH FOR TYMPANOPLASTY

Tympanic membrane perforation is a common pathology encountered by an ear surgeon. The surgical repair and reconstruction of these defects of the drumhead has been addressed by two popular techniques - viz., the common and popular underlay technique and the lesser known interlay technique. In underlay technique of tympanoplasty, mucosalization of the graft many a times leads to continuous or intermittent discharging ear despite an intact tympanic membrane - and this has been called the “Red Drum Conundrum”. Total annulus excision (TAE) implies that the entire annulus is removed along with remnant of tympanic membrane during the procedure to surgically reconstruct a diseased membrane. TAE is an essential step of a broader technique of interlay technique. This novel Interlay technique’s basic premise is that - Once the graft is placed, there must not be any mucous membrane lateral to the graft and no epithelium medial to the graft. One very important benefit of TAE is neovascularization around the graft. Total annular excision is a new emerging technique of tympanoplasty as it gives patient a three layered physiologically and anatomically near natural membrane with good vibratory function without possibility of weeping membrane or granular myringitis. Key Words: Annulus, tympanoplasty, interlay, middle ear, tympanic membrane, Myringoplasty